The USPSTF Updates Recommendations for Cervical Cancer Screening

The US Preventive Services Task Force (USPSTF) released a statement with updated recommendations regarding cervical cancer screening, including varying recommendations and types of screening based on a woman’s age along with other factors.

This updated recommendation replaces the 2012 USPSTF recommendation and was published in JAMA (2018 Aug 21. Epub ahead of print).

The USPTF reviewed evidence on cervical cancer screening, focusing on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus testing alone or along with cytology compared to cervical cytology alone. Using a decision analysis model, they evaluated the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies.

Based on their findings, the USPTF recommends:

• Screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years.
• Screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus testing alone, or every 5 years with high-risk human papillomavirus testing in combination with cytology in women aged 30 to 65 years.

The USPTF recommends against:

• Screening for cervical cancer in women younger than 21 years.
• Screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at risk for cervical cancer.
• Screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of high-grade precancerous lesion or cervical cancer.

“The major change in the current recommendation is that the USPSTF now recommends screening every 5 years with [high-risk human papillomavirus] testing alone as an alternative to screening every 3 years with cytology alone among women aged 30 to 65 years,” the authors noted.  “Cotesting as an alternative strategy has demonstrated similar effectiveness, although it may result in more tests and procedures compared with either cytology or [high-risk human papillomavirus] testing alone.”—Janelle Bradley